€¦ · (met) nurse, several staff nurses and nurse managers, and a representative from the risk...

The Official Publication of the American Academy of Ambulatory Care Nursing

Page 3Collaborating withSpecialty NursingOrganizationsThe Oncology Nursing Societyrecently held a collaborativemeeting of nursing associationsto address education gaps fornon-oncology nurses caring forpatients with cancer.

Page 4Green Health Care &Nursing PracticeWhat impact does the healthcare industry have on ourplanet? Learn what you can doto help change environmentalpractices at work and home.

Page 7AAACN News

• New AAACN Publications• Member-Get-a-Member

Campaign Recruits 140New Members!

5Telehealth Trials & TriumphsThe Power of Words

Page 16New AAACN Board andNominating CommitteeMembers Elected

Volume 32 Number 2

MARCH/APRIL 2010

Falls are a major healthproblem, especially amongolder adults. It is estimatedthat one in three people over

the age of 65 experience a fallat least once a year (CDC, 2008).

Falls are the leading cause of injury-relateddeaths and non-fatal injuries in persons overthe age of 65. Many of these falls result ininjuries that impact their quality of life andability to live independently. More than 90percent of hip fractures among adults 65 orolder are caused by falls, and one in five hipfracture patients die within a year of theirinjury (CDC, 2008). Prevention of falls isclearly a safety priority and is a NationalPatient Safety Goal - reduce the risk ofpatient harm resulting from falls (JointCommission, 2009).

While there is ample evidence to sup-port effective components of an inpatientfalls prevention program, there is lessresearch-based evidence that outlines aneffective ambulatory fall prevention pro-gram. To address the issue of falls, anAmbulatory Falls Prevention ProcessImprovement Team was formed at theambulatory care facility at Mayo Clinic inArizona. The purpose of this multi-discipli-

nary fall prevention team was to exploremethods to prevent falls. The team waschaired by a clinical nurse specialist andincluded a quality management nurse, twonursing education specialists, two physicaltherapists, the Medical Emergency Team(MET) nurse, several staff nurses and nursemanagers, and a representative from theRisk Management department.

When preparing any new fall preventionstrategy, it is important to include key stake-holders to achieve a successful outcome.Having the support of experts and frontlinestaff in implementing new processes helps toensure the success of the program (Dlugacz,Restifo & Greenwood, 2004). The team atMayo Clinic met monthly to review falls data,analyze fall risk assessment audits, andexplore methods to further reduce the inci-dence of falls. The team also developed theFall Risk Assessment policy and was responsi-ble for keeping it updated.

In order to accurately assess the scopeof an issue, the issue and contributing fac-tors must first be defined. The team deter-mined that one of the first steps was toclearly define a fall. The definition of a fallwas adapted from the National Database ofNursing Quality Indicators (NDNQI) which

Continuing NursingEducationEducationEducation

FREE

continued on page 8

Become a Fan of AAACN on Facebook

Connect with colleagues, share photos, exchange ideas,

and more!www.facebook.com/AAACN

Contact hour instructions, objectives, and accreditation information may be found on page 11.

Karen Seifert

Viewpoint_MA10.qxd 3/17/10 4:07 PM Page 1

AReflecting on a Wild Ride

At the end of our Las Vegas conference in May, I willbe turning over the presidency of AAACN to my goodfriend and colleague, Traci Haynes. As my presidencycomes to a close, I would like to reflect on the past year.

This year has been a wild ride with the economicdownturn coloring the AAACN Board of Directors’ (BOD)every decision. Many times I felt like a surfer riding a bigwave and making sure it did not engulf us (AAACN)! Wesaw our investments decline for a period of time, but as ofnow, they seem to have recovered. Our membershipnumbers have dropped, impacting our budgets this pastyear and for 2010. The staff and the BOD have cut back expenses wherever pos-sible. The organization has reserves to help us meet our financial obligations thisyear.

Besides the monetary impact, an unexpected consequence of a decreasedmembership is fewer volunteers to carry out the work of the organization. The BODis very concerned but understands that the work environment for our members hasdrastically changed during this past year. The biggest challenge for our volunteersis a lack of time to devote to AAACN activities. In response, the BOD has asked ourSIGs and committees to re-prioritize their work. The BOD has also taken a hard lookat our strategies for the rest of this year and the next. We value the time and com-mitment of our members. AAACN has always turned out quality products, and wewant to make sure our volunteers are able to continue to do so.

This past year we implemented several new initiatives that we anticipate willhelp us weather this financial downturn, as well as effectively communicate withour members. Staff is using e-mail for many communications to members, includ-ing renewals. We are also using the Web site more often to communicate withour members. We conduct our elections online and quickly gather information viaonline member surveys. AAACN has made the Online Library (www.prolibraries.com/aaacn) available for obtaining information from past confer-ences, even if you could not attend or if you want to hear a speaker’s presenta-tion that you missed. The Online Library provides you many opportunities toenhance your practice through continuing education. Take advantage of the freeViewPoint contact hours that can be used for recertification and relicensure.

Throughout 2010, we will be looking at ways to help members communicateand network with each other at any time, not just during office hours. Results ofa survey sent to members will identify the ways you prefer to "connect" with eachother online and via the AAACN Web site. The BOD will review member inputand determine how AAACN can enhance member connectivity. We hope this willallow more members to participate, share their knowledge, and benchmark prac-tices across the country.

We also look forward to publishing the next edition of the Scope andStandards of Practice for Professional Ambulatory Care Nursing. This edition will con-tain significant changes such as the addition of the scope of practice and theupdated conceptual framework for ambulatory care nursing. Sixteen standardsare categorized into two classifications: the nursing process and professional per-formance standards. Another publication on the horizon is the second edition of

2 ViewPoint MARCH/APRIL 2010

Reader ServicesAAACN ViewPointAmerican Academy of Ambulatory Care NursingEast Holly Avenue Box 56Pitman, NJ 08071-0056(800) AMB-NURSFax: (856) 589-7463E-mail: [email protected] site: www.aaacn.org

AAACN ViewPoint is owned and publishedbimonthly by the American Academy ofAmbulatory Care Nursing (AAACN). Thenewsletter is distributed to members as adirect benefit of membership. Postage paid atDeptford, NJ, and additional mailing offices.

AdvertisingContact Tom Greene, AdvertisingRepresentative, (856) 256-2367.

Back IssuesTo order, call (800) AMB-NURS or(856) 256-2350.

Editorial ContentAAACN encourages the submission of newsitems and photos of interest to AAACN mem-bers. By virtue of your submission, you agreeto the usage and editing of your submissionfor possible publication in AAACN's newslet-ter, Web site, and other promotional and edu-cational materials.

To send comments, questions, or article sug-gestions, or if you would like to write for us,contact Managing Editor Linda Alexander [email protected]

AAACN Publications andProductsTo order, visit our Web site: www.aaacn.org.

ReprintsFor permission to reprint an article, call(800) AMB-NURS or (856) 256-2350.

SubscriptionsWe offer institutional subscriptions only. Thecost per year is $80 U.S., $100 outside U.S.To subscribe, call (800) AMB-NURS or (856)256-2350.

IndexingAAACN ViewPoint is indexed in theCumulative Index to Nursing and AlliedHealth Literature (CINAHL).

© Copyright 2010 by AAACN. All rightsreserved. Reproduction in whole or part, elec-tronic or mechanical without written permissionof the publisher is prohibited. The opinionsexpressed in AAACN ViewPoint are those of thecontributors, authors and/or advertisers, and donot necessarily reflect the views of AAACN,AAACN ViewPoint, or its editorial staff.

Publication Management by Anthony J. Jannetti, Inc.

Kitty Shulman

continued on page 11

Viewpoint_MA10.qxd 3/12/10 4:21 PM

WWW.AAACN.ORG 3

The Oncology Nursing Society (ONS) was recentlyawarded a grant by the Susan G. Komen Foundation toaddress gaps in education for non-oncology nurses andnursing students caring for patients with cancer. InDecember, I represented AAACN at a collaborative meet-ing of 20 nursing organizations that ONS held inPittsburgh to discuss care across the continuum.

At the meeting, we discovered that each organization’smembers play a part in the ongoing care of patients withcancer. Many interact during a focused portion of the caretrajectory while others are more global, impacting carethroughout the life span. A consistent theme emerged:whether the contact was short or long term, nurses feel itis their duty to provide education on prevention and symp-tom management, as well as guidance on personal issuessuch as sexuality.

During the brainstorming sessions, we also discussededucational needs of the non-specialist and identified sev-eral areas in which nurses may need a review: cancerpathophysiology, instruction on core competencies forcancer care, and how to facilitate or participate in a multi-specialty collaborative approach to care. We also deter-mined a need to improve clinical knowledge, coordinationof care, and management of co-morbidities.

In addition, nurses need education on the many barri-ers they may face when dealing with patients with cancer.Patients may have the attitude that ‘cancer equals death’or a nurse may experience poor communication with fam-ily members when determining who should provide care.Other challenges include fragmentation of care, patientnon-compliance due to ill-defined guidelines or as a resultof a fear of reoccurrence, the impact on families of func-tional disability, and long-term care needs with advanceddisease.

While research has had a long-term impact on identi-fying evidence-based care options, we have to rememberhealth care is not always at the bedside in a hospital, butalso at home provided by self-directed partners. Otheroptions could be palliative outpatient clinics, many man-aged by nurse practitioners or hospice which is a growingpartner for providing end-of-life care.

The group looked for synergies that could promote bet-ter care of patients with cancer. Nursing organizations agreedto facilitate this by providing educational collaborationthrough conference presentations, journal articles, and sharedlinks on organizational Web sites. ONS offered its ‘Clinical

Collaborating with Specialty Nursing Organizations inCaring for People with a Cancer Diagnosis

There’s no better time to be a nurse at Duke Medicine, a world-class health care system dedicated to providing outstanding, compassionate care for our patients and a lifetime of rewarding opportunities for our nurses.

Our hospitals, ambulatory surgery centers, and primary and specialty care clinics are located throughout the Triangle region of North Carolina, nationally recognized as great places to live and work:

For more information on how you can become a Duke nurse,

visit dukenursing.org.

Duke Medicine prohibits discrimination and harassment, and provides equal employment

opportunity without regard to race, color, religion, national origin, disability, veteran status,

sexual orientation, gender identity, sex, or age.

U.S.News & World Report ranked Durham as one of the best

places to live in the country.

Forbes magazine ranked Raleigh #1 and Durham #3 on its list of

the country’s best cities for business and careers in 2009.

Carolina Parent, Computer World, Nursing Professionals,

AARP, and Modern Healthcare named Duke Medicine a best

place to work.

Come for the job.Stay for the benefits.

OPPORTUNITIES FOR A LIFETIME

400371812 Ambulatory Nurse - Medicine

400363532 Ambulatory Nurse - Urology

400362374 Nurse Manager - Urology

400357871 Ambulatory Care Nurse I - Surgery & Cardiac Clinic

Now seeking qualified candidatesfor nurse positions:

Duke University Hospital, Durham RegionalHospital, and Duke Raleigh Hospital are veryproud to have achieved Magnet designation.

continued on page 11


Health CareNursing Practice


tals are the largest employer, producethe most waste, and are major con-sumers of utilities, such as water andenergy. In fact, a 2006 statistic by theDepartment of Labor cites health careas the largest industry in the UnitedStates, providing 13.5 million jobs(Shaner-McRae, McRae, & Jas, 2007).

The demand for resources increas-es every day. Construction, both inthe form of renovations and new facil-ities, is booming and is slowing onlyminimally in the present economy.While outdated buildings may need tobe replaced and refurbished in orderto provide care, this building boom inhealth care is not necessarily good forthe environment – the bigger theindustry, the bigger its potential eco-logical footprint.

No one knows the precise size ofthe health sectors’ global ecologicalfootprint, but we know that it is sub-stantial. In all industrialized and manydeveloping countries, provision ofhealth care services is a massive energy-intensive activity. The health sector isalso a major consumer of water, elec-tronics, medications, food, and otherresources.

One of the most obvious exam-ples of health care’s giant ecologicalfootprint is the amount of garbageproduced. Practice Greenhealth esti-mates that in 2006, health care facili-ties across the United States producedabout 6,600 tons of waste every day(Department of Labor, 2006). Thisnumber has doubled since 1955,largely due to increased use of dispos-able products. Annually, this amountsto more than 5 million tons of trashbeing dumped into the nation’s land-fills (Department of Labor, 2006).

The disposal of solid waste pro-duces greenhouse gas emissions in anumber of ways. First, the anaerobicdecomposition of waste in landfillsproduces methane, a greenhouse gas21 times more potent than carbondioxide. Second, the incineration ofwaste produces carbon dioxide as aby-product. In addition, the trans-portation of waste to disposal sitesproduces greenhouse gas emissionsfrom the combustion of the fuel usedin the equipment. Finally, the disposalof materials indicates that they arebeing replaced by new products; thisproduction often requires the use offossil fuels to obtain raw materials andmanufacture the items (Brown, 2010).

While dumping massive amountsof trash in landfills poisons our envi-ronment, disposing of health carewaste by burning is even worse.Incineration releases such toxins asdioxin, mercury, and other heavy met-als into the air (Sattler & Condon,2003; EPA, 2007). Dioxin is a knowncarcinogen and is created whenpolyvinyl chloride (PVC) is incinerated.PVC plastics are prevalent throughouthospitals in such items as catheters,oxygen masks, tubing, and gloves.Mercury is a potent neurotoxin foundin thermometers, blood pressurecuffs, and many other health caredevices. Although mercury has beenlargely phased out from most U.S.hospitals and health care facilities, it isstill widely used in developing coun-tries and continues to persist in ourenvironment.

Biomonitoring studies conductedby the Environmental Working Groupreveal that mercury accumulates inthe human body, and even morealarming, in breast milk and umbilical

It is ironic that as nurses, we workto prevent disease and promotehealth, yet our work often has unin-tended consequences, such as creat-ing pollution, which ultimately harmshuman health. To better serve ourpatients and communities, we have avital responsibility to see the big pic-ture when it comes to what we con-sume and what we leave behind whiledoing the work of healing.Understanding the health care indus-try’s ecological footprint is a goodplace for nurses to start.

William Rees, a Canadian ecolo-gist and professor at the University ofBritish Columbia, is credited with firstusing the term “ecological footprint”in 1992 (Rees & Wackernagel, 1995).An industry’s ecological footprint is itsdemand on the planet’s naturalresources. Hospitals, health centers,and other health care facilities con-sume vast amounts of fossil fuels,water, and land and forestry products.

Health Care’s EcologicalFootprint

One way to grasp the enormity ofthe health care industry’s ecologicalfootprint is to be familiar with statisticsabout the health care sector.According to the American HospitalAssociation (AHA), there are currently5,815 hospitals in the United Statesproviding around-the-clock care and5,010 community hospitals providingshort-term or specialty care (AHA,2010). In many communities, hospi-

Anna Gilmore Hall


WWW.AAACN.ORG 5

cord blood (Environmental WorkingGroup, 2005). Fortunately, the publicand the health care industry havestarted to recognize that medicalwaste incineration is a very hazardouspractice, and the number of incinera-tors dropped from more than 5,000 in1996 to less than 800 in 2007 (Sattler& Condon, 2003; EPA, 2007).

Not only does health care wastetranslate into lost dollars and resources,it is also a reflection of our inefficiencyand lack of foresight regarding futuresustainability. Although the health carewaste stream is very complex anddiverse, the bulk of it is actually justnormal household trash, otherwiseknown as solid waste, consisting ofpaper, plastic, food waste, beveragecontainers, and supply packaging.Many of these items can easily be recy-cled, or better yet, we can stop themfrom entering the waste stream.Through judicious purchasing, recy-cling, composting, and re-use, we cangreatly reduce the volume of solidwaste going to our landfills.

Health Care Sector –Leadership Role

Because its ecological impact is sovast, the health sector can play amajor role in mitigating efforts toimprove environmental practicesaround the world. As members of theWorld Health Organization’s (WHO)Health Security and EnvironmentalCluster wrote recently in the AmericanJournal of Preventive Medicine, “Thehealth sector is one of the most trust-ed and respected sections of society;and it is one of the largest employersand consumers of energy. This pres-ents both a responsibility and anopportunity to be an ‘early mover’ toachieve climate neutrality in its ownoperations, and to demonstrate thatthis can go hand-in-hand withimproved effectiveness and cost sav-ings” (Neira, Bertollini, Campbell-Lendrum, & Heymann, 2009, pp.424-425).

As nurses, we know that if thehealth care sector is going to assumethis responsibility and leadership posi-tion, it cannot be successful withoutthe strong, active support of nurses.

Florence Nightingale was a strongenvironmental advocate. She under-stood the link between environmentand health. In her book Notes onNursing, she emphasized the need forclean air and water. She made it clearthat nurses must assume responsibilityfor the environment to promote posi-tive life processes (Nightingale, 1890).

I think she would agree that ourpatients, their families, and our com-munities are under threat. We have anobligation to learn about this threat,engage our nursing skills, speak thetruth, and guide public policy forhealthy environments. We are obligat-ed to assist the health care sector inassuming its leadership positionaround climate mitigation strategies.

Nursing Action Required!Nurses, both individually and col-

lectively, have ample opportunities tochange environmental practices in theplaces where they work and live. Thefirst step toward creating a greenerenvironment is making a consciouseffort to become aware of waste bybringing what is normally part of thebackground scenery into focus. Wemust recognize that all of the supplies,packaging, and materials that enter ahealth care facility eventually maketheir way into the environment if theyare not recycled. These things eitherincrease the size of our landfills or pol-lute our air when incinerated. Nursesand others can use this knowledgewhen making decisions about pur-chasing supplies, using supplies, andthrowing anything into the garbagecan.

When there is a choice, we needto choose environmentally preferableproducts. This means considering theimpact of the products used from thetime they are created to their disposaland beyond, including the length oftime they will take to decompose in alandfill. As the front line workers whowill use these supplies to care forpatients, nurses must become involvedin purchasing decisions and advocatefor sustainable products.

Health care’s waste stream ismuch more complicated than simply

garbage. It includes biohazard waste,pharmaceutical waste, chemicalwaste, and various other toxins. Eachwaste stream comes with its own setof unintended environmental conse-quences. For example, improper dis-posal of unwanted or expired medica-tions (usually flushed down the toilet,thrown in the trash, or even burned)has resulted in a degradation of waterand air. There are many stories in thepopular press and in scientific journalsreporting detectable concentrationsof pharmaceuticals, including antibi-otics, antidepressants, birth controlpills, chemotherapeutic agents, andpainkillers, among others, in our watersupply (ANA, 2004). While the impactof these drugs in water is not fullyunderstood, increasing concerns fromscientists, the medical community,and the public demand that nursesget involved in developing best prac-tices for proper medication disposal.

Nurses as Change AgentsAre all of the current practices in

your workplace sustainable? Aschange agents, patient advocates,and members of one of the mosttrusted professions, there is muchnurses can do to influence policy andcreate a healthier environment. Thefirst step is learning more about theimpact of the health care industry onthe environment. Once we educateourselves, we can then provide work-shops and other forums to educateour co-workers and the public.Practice Greenhealth and Health CareWithout Harm are two great resourcesto jumpstart the learning process.

Another way to get involved is tojoin your workplace “green team,” agroup whose mission is to provideeducation about waste reduction andrecycling. If a “green team” does notexist in your workplace, why not cre-ate one? Not only will you meet peo-ple from outside of your own clinicalarea, you will gain a much broaderperspective and appreciation for theamount of resources required to oper-ate a hospital, clinic, or medical office.



Lastly, take a look around yourworkplace for opportunities to reducewaste. Start a small recycling programor include some “green” facts in anewsletter. Don’t underestimate yourown power to create change. Simplesteps such as bringing in a reusablemug or water bottle from home insteadof grabbing a new styrofoam cup everytime you need a beverage can go along way toward reducing the overallvolume of our ecological footprint.

Organized nursing is also engag-ing its members on the importance ofsustainability and nursing practice.The American Nurses Association’s2004 House of Delegates passed anAction Report on the Creation ofEnvironmental Health Principles basedon a simply stated but a very impor-

tant assumption: Human health islinked to the quality of the environ-ment (ANA, 2004). In 2007, ANA sub-sequently published its Principles ofEnvironmental Health for NursingPractice with Implementation Strategiesas a guide to environmentally respon-sible nursing practice. For many nurs-es, this science and evidence is newand not something learned in nursingschool and college. As scientific stud-ies increasingly point to the linkbetween environmental exposuresand chronic disease, nurses mustunderstand these links as part of theirpractice and incorporate these princi-ples into every day activities.

Nurses have a duty to act as healthadvocates, demonstrating an ethicalapproach, as well as communicatepotential health risks associated withenvironmental hazard exposures(Herberer, 2002). Nurses can utilizesome basic principles to help guidethem in becoming effective environ-mental and patient advocates. ThePrecautionary Principle embraces thenotion of “first, do no harm.” Actionsthat have the potential to cause severeor irreversible harm to health requireprecautionary approaches, regardlessif the cause and effect relationships arenot fully known (Institute of Medicine,2004). For example, some childhoodcancers may have been prevented hadwe considered the potential for harm-ful effects of such health care interven-tions as pelvimetry (an X-ray methodfor diagnosing) (Sunstein, 2005).

Nursing’s role in reducing andeliminating environmentally relateddisease and reducing health care’secological footprint is part of our prac-tice, our covenant with the public andthe public’s health. Nurses are viewedby the public as the most respectedand trusted occupation and the voicethat they listen to most often. We canmake a difference in communities, inpublic policy, and in the lives of futuregenerations. The need to act is now.

Anna Gilmore Hall, RN, is ExecutiveDirector, Health Care Without Harm,Reston, VA. She can be reached [email protected]

Resources for Nurses• Health Care Without Harm

(HCWH) (www.noharm.org):Offers information about theimpact of health care on theenvironment and strategies tohelp protect it.

• Practice Greenhealth(www.practicegreenhealth.org):Working to create a nationalmovement for environmentalsustainability in health care.Provides many tools for hospitalsand health care systems to usein making facilities “greener.”

• EnviRN:www.envirn.umaryland.edu

• RNnoHarm: www.nursingworld.org/mainmenucategories/OccupationalandEnvironmental/

• The Luminary Project:www.theluminaryproject.org

• Campaign for Safe Cosmetics:www.safecosmetics.org

• Center for Health, Environmentand Justice: www.chej.org

• Environmental Working Group:www.ewg.org

• Sustainable Hospitals:www.sustainablehospitals.org

ReferencesAmerican Nurses Association (ANA). (2004).

2004 House of Delegates resolution:Environmental health principles in nursingpractice. Retrieved from www.nursingworld.org/2004hod/resenviron.pdf

American Hospital Association (AHA). (2010).Fast facts on U.S. Hospitals. Retrievedfrom http://www.aha.org/aha/resource-center/Statistics-and-Studies/fast-facts.html

Brown, J. (2010). Waste management's role inenvironmental sustainability. Greenhealth,1(2), 18.

Department of Labor. (2006). Career guide toindustries, 2010-11 Edition: Healthcare.Retrieved from http://www.bls.gov/oco/cg/cgs035.htm

Environmental Working Group. (2005).Body burden: The pollution in newborns.Retrieved from http://www.ewg.org/reports/bodyburden2/execsumm.php

Environmental Protection Agency (EPA).(2007). General information on the linkbetween solid waste and greenhouse gasemissions. Retrieved from http://epa.gov/c l i m a t e c h a n g e / w y c d / w a s t e /generalinfo.html

Herberer, T. (2002). Occurrence, fate, andremoval of pharmaceutical residues inthe acquatic environment: A review ofrecent research data. Toxicology Letters,131(1-2), 5-17.

Institute of Medicine. (2004). Keepingpatients safe: Transforming the workenvironment of nurses. Washington, DC:National Academy Press.

Neira, M., Bertollini, R., Campbell-Lendrum,D., & Heymann, D.L. (2008). The year2008: A breakthrough year for healthprojection from climate change?American Journal of Preventive Medicine,35(5), 424-425.

Nightingale, F. (1890). Notes on nursing.What it is and what it is not. New York,NY: D. Appleton and Company.

Sattler, B., and Condon, M. (2003). Theproblems posed by medical waste inciner-ation. Retrieved from http://www.h2e-online.org/docs/marylandnurse20103.pdf

Sunstein, C.R. (2005). Laws of fear: Beyondthe precautionary principle. New York,NY: Cambridge University Press.

Rees, W., & Wackernagel, M. (1995). Ourecological footprint: Reducing humanimpact on the Earth. Gabriola Island,BC, Canada: New Society Publishers.

Shaner-McRae, H., McRae, G., & Jas, V. (2007).Environmentally safe health care agencies:Nursing’s responsibility, Nightingale’slegacy. The Online Journal of Issues inNursing, 12(2). Retrieved fromhttp://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No2May07/EnvironmentallySafeHealthCareAgencies.aspx


WWW.AAACN.ORG 7

Two Hot-off-the-Press Publications To Be Introduced at the Conference

Members and colleagues attending the Las Vegas conference will be the first nurses to see and purchase AAACN’s newest resources.

Scope and Standards of Practice for Professional Ambulatory Care Nursing, 8th Edition, 2010

The Scope and Standards of Practice forProfessional Ambulatory Care Nursing explicitlyidentifies and defines ambulatory nursing prac-tice in outpatient settings. The first formal Scopeof Practice statement contains a definition ofambulatory care practice, an expanded concep-tual framework, practice characteristics, roles ofprofessional ambulatory care nurses, and trendsand issues in ambulatory care settings and nurs-ing practice.

Sixteen standards are categorized into twomajor classifications: the nursing process andprofessional performance. Each standard con-tains distinct measurement criteria to clarify the domains of clinical andadministrative practice.

The Scope and Standards provides an invaluable guide for ambulatorycare settings to guide nursing competencies; improve or create policies, pro-cedures and standards; train and orient staff; create clinical, telehealth, andadministrative job descriptions; and plan for regulatory agency surveys.Nurses will also find this resource helpful in preparing for the ambulatorycare nursing certification exam.

Member Price: . . . . . . . .$29 Non-member price: . . . . . . . .$44

Ambulatory Care Nursing Orientation and Competency Assessment Guide, 2nd Edition, 2010

The Ambulatory Care NursingOrientation and Competency AssessmentGuide serves as a valuable resource fororienting nurses new to ambulatorycare as well as developing compre-hensive competency assessment pro-grams. A wide selection of age-specificand specialty care topics are covered,including telehealth. The updatedguide contains many enhancements:

• Updated content plus definitions, key tips, and examples• Chapters on nurse educator competencies, defining the educator’s role

in ambulatory care, and providing guidance and tools for developingcompetencies

• Tool kit for transitioning to ambulatory care with many helpful linksand resources

• Appendix containing sample orientation and competency toolsMember Price: . . . . . . . .$65 Non-member price: . . . . . . . .$79

Order your copies of these valuable resources atwww.aaacn.org

Member Get-a-MemberCampaign Recruits 140

NEW Members!Many members were busy in 2009 pro-

moting the benefits of AAACN membershipto their colleagues. With your help, weadded 140 new members to the association!

AAACN extends itsspecial thanks to everymember who recruitednew members. Twomembers each recruitedat least six new members– Vickie Leger recruitedseven new members andCarol Rutenberg recruit-ed 15 new members! Carol received the topaward – registration to the Las Vegas confer-ence, plus hotel and airfare. Linda Brixey andBridget K. Jackson each recruited three newmembers, and they received a $100 AAACNcertificate. Thank you to everyone whohelped AAACN grow this year!

Recruit the most new membersbetween April 1 - Dec. 31, 2010,

and WIN a trip to AAACN's 36th Annual Conference in

San Antonio, TXThe AAACN member who recruits the

most new members (six or more) in 2010will win a trip to AAACN's 36th AnnualConference in San Antonio! The winner willreceive paid registration, airfare (maximumof $400), and three nights lodging at theconference hotel (double occupancy).Members who recruit three or more newmembers will receive a $100 gift certificateto AAACN - good for AAACN programs andproducts!

Encourage your colleagues to joinAAACN! To qualify for prizes, make sureyour name goes in the "referred by" sectionon the membership application. You candownload the application from the Web siteor contact the National Office to obtain asupply of applications. Thank you and goodluck!

geta

Member Member

Carol Rutenberg



states a fall is “an unplanned descentto the floor (or extension of the floor,e.g. trash can or other equipment)with or without injury to the person,and occurs within an ambulatory set-ting. All types of falls are to be includ-ed whether they result from physio-logic reasons (e.g., fainting) orenvironmental reasons (e.g., slipperyfloor). This includes assisted falls(when a staff member attempts tominimize the impact of the fall)”(NDNQI, 2009). The team chose thisdefinition to be consistent with thehospital as well as national standardsto be able to compare Mayo Clinic fallrates with other sites. Another step inunderstanding the data to collect wasto ask the all-encompassing questions:Who is falling? Where are falls occur-ring? Why are falls occurring? Whenare falls occurring?

There are intrinsic and extrinsicfactors that contribute to falls (seeTable 1). Intrinsic factors are related toa patient’s condition or disease state.These may include physical functionsuch as poor vision, muscle weakness,gait or balance problems, dizziness,and bowel or bladder control prob-lems. Extrinsic factors are related tothe environment and safety issues,including inadequate lighting in aroom, objects on the floor, poorfootwear, or assistive devices out ofreach (McCarter-Bayer, Bayer, & Hall,2005).

The Ambulatory Falls PreventionProcess Improvement Team utilizedthe Plan-Do-Check-Act (PDCA)methodology for the processimprovement plan. The PDCA cycle iscontinuous, repeating itself over andover again, with no beginning or end,and naturally involves overlappingamong the stages (Dlugacz, Restifo, &Greenwood, 2004). Some basicassumptions of the PDCA methodinclude:

a) Decisions should be based onfacts instead of hunches and intu-ition.

b) People who perform the workknow it best.

c) Teams can have more successthan individuals working alone.

d) Teams need to be trained inproblem solving processes.

e) It helps to display informationgraphically (Sandras, 1995).

Plan Phase - ExaminePolicies and Prepare forData Collection

During the planning phase, theteam planned how to collect the fallsdata. The quality management repre-sentative collated data from severalsources: occurrence report forms,security reports, and MET (MedicalEmergency Team) nurse reports (com-pleted when a fall occurs). After athorough review, the team concludedthat it needed additional information.An Ambulatory Fall Report Form wasdeveloped, complete with a demo-graphics section to include importantinformation such as name of personwho fell, date, location, and descrip-tion of the fall. In a contributing fac-tors section, other details could beadded: symptoms prior to the fall, useof assistive devices, activity prior to thefall, and injuries sustained (if any).After completion, this report form wassent to the Quality Managementdepartment for review and inclusionin the data collection.

Another component in the plan-ning phase was to examine thepatient care policy on ambulatory fallrisk assessment for any necessary revi-sions and updates. According to the

policy, four designated departmentswere required to complete a Fall RiskAssessment on every patient seen intheir department. The team includedareas in which patients return forongoing treatment and/or therapy atall ambulatory locations: theOutpatient Infusion Center, theHematology/Oncology Therapy Unit,Radiation Oncology, and Physical andOccupational Therapy.

The policy also described whenpatients were to be reassessed if therewas a significant change such as arecent history of falls, new cognitiveimpairment, new functional or mobil-ity problems, or new balance impair-ment. The policy described levels ofinjury using the NDNQI descriptions:

• None - Patient had no injuriesresulting from the fall.

• Minor - Resulted in application ofa dressing, ice, cleaning of awound, limb elevation, or topicalmedication.

• Moderate - Resulted in suturing,applications of steri-strips, skinglue, or splinting.

• Major - Resulted in surgery, cast-ing, or traction, or required con-sultation for neurologic or internalinjury.

• Death - The patient died as aresult of injuries sustained fromthe fall (not from physiologicevents causing the fall) (NDNQI,2009).

Intrinsic Factors Based on individual or disease state

Extrinsic FactorsEnvironmental and safety issues

Physical Function: Poor vision, muscleweakness, dizziness Wet/slippery floor

Problems with bladder and/or bowelcontrol Equipment in the way

Altered mental status (confused, disoriented) Object on the floor

Gait and/or balance problems Cane, walker, or crutches out of reach

Previous history of falls Inadequate lighting in the room

Medications: Antihypertensives, psy-chotropics, anti-epileptics, sedativesand hypnotics, polypharmacy

Poor footwear (non-supportive, slippers, ill-fitting)

Table 1.Factors Contributing to Falls

Source: Adapted from McCarter-Bayer, Bayer, & Hall, 2005.

We’re Not Falling for Thatcontinued from page 1


WWW.AAACN.ORG 9

A fall was considered a fall withinjury if a documented interventionwas provided. The quality manage-ment nurse assigned the level of injury(if any) based on the details of the fallobtained from the incident report andthe Fall Assessment Report Form.

Do Phase - Complete FallRisk Assessment and DataCollection

Although there are several validat-ed fall risk assessment tools for inpa-tient and long-term care facilities, anextensive literature search did notreveal a standardized or validated toolfor the ambulatory clinic setting.Therefore, the clinical nurse specialist,with assistance from the team, devel-oped an Ambulatory Fall RiskAssessment Tool, which asks thesequestions:

1. When was the last time you fell?(Past week, month, threemonths, six months, past year,or not applicable)

2. When you fell, were you injured?3. If you answered “yes” to num-

ber 2, explain your injury.4. Have you experienced bowel or

bladder urgency or frequencywithin the past six months?

5. Have you experienced episodesof dizziness in the past sixmonths?

6. Do you require assistance withwalking? (If yes, what do youuse? Another person, cane,walker, motorized device, rail-ing, crutches, wheelchair, orother)

Based on the results of theAmbulatory Fall Risk Assessment Tool,patients who have fallen within thepast year, or who answer “yes” to atleast one of the questions, are consid-ered “at risk” for falling. There is nodetermination of level of risk; thepatient is either at risk or not at risk. Inthe lower section of the assessmenttool, the licensed health care profes-sional indicates what intervention(s)and patient education were providedto the patient. The Ambulatory FallRisk Assessment is documented in theelectronic medical record.

The four designated areas com-plete an Ambulatory Fall RiskAssessment audit on a quarterly basis

to assess compliance with completingthe fall risk assessment tool and todetermine if the appropriate interven-tion was initiated if the patient wasassessed as a fall risk.

Education - A KeyComponent

Staff education regarding theidentification of patients at risk for fallsand prevention of falls is a key compo-nent to reducing the incidence of fallsin any setting. Several examples in theliterature demonstrate the positiveeffect staff education has on decreas-ing falls in a variety of settings(Murphy, Labonte, Klock, & Houser,2008; Peterson & Berns, 2006;Wright, Goldman, & Beresin, 2007). Astaff education program was devel-oped which focused on identifyingthe patients at risk for falls and stepsthat every staff member could take toprevent patient falls. Syncope hasbeen shown to be a high risk factor forfalls, with an estimated 30% of falls inan ambulatory setting related to syn-cope (Peterson & Berns, 2006).

The team focused its educationefforts initially with all laboratory staffand expanded the program to includeradiology staff, all new ambulatorycare employees, and staff at the pri-mary care clinics. Realizing the impor-tance of communicating fall preven-tion to all staff, the team alsodeveloped a mandatory online educa-tion module. Staff education empha-

sized the need to communicate acrossall sites if a patient was at risk for fallsor had fallen. An Ambulatory FallPrevention Pocket Guide (see Figure1) was developed and provided to allstaff. The guide outlines fall risk factorsand what interventions to take to pre-vent falls.

Equally important as staff educa-tion is patient education. Nurses in theorthopedic department initiated pre-operative patient education sessionsfor patients having total knee replace-ment surgery. This program hasproven to be highly effective in pre-venting the incidence of post-opera-tive falls. Additional patient educationefforts in the ambulatory settingincluded providing patient educationmaterials on preventing falls at homeand in the hospital. Currently, theAmbulatory Falls Prevention ProcessImprovement Team is discussing thebest method to provide these educa-tional materials to all patients. Forpatients at a high risk for falls, educa-tion is necessary for family membersand caregivers as well.

Check Phase - Analyze Data,Focus on Outcomes

During the check phase, the teamanalyzed falls data to see if the sug-gested interventions (change inprocesses, revisions in policies, andstaff and patient education) have pro-vided the anticipated outcomes. Fall-related outcomes were selected based

Ambulatory

Fall Prevention Guide

Figure 1.Ambulatory Fall Prevention Pocket Guide



on the goals of the individual,providers, and organizations (Lyons,2005). The outcome indicator select-ed by the team was a decrease in theoverall number of falls in the ambula-tory setting.

Since initiating the FallsPrevention Team, the group has seena decline in the incidence of falls (seeFigure 2). Although it is difficult todetermine the exact reason for thereduction in falls, the team believesincreased awareness and strong staffand patient education efforts havehad a positive impact on fall rates.Educating all staff, including generalservice, volunteers, and desk staff (notjust nursing) about identifyingpatients who need assistance withambulation has had a positive effect. Itis important to engage all staff mem-bers to ensure consistent implementa-tion of a fall prevention program(Murphy et al, 2005).

Act Phase - CommunicateSuccess and MaintainImprovements

It is important during this phaseto communicate to all levels the out-comes of the process improvementefforts. In order to sustain the changeand improvements, one needs tocommunicate the project’s outcomesacross the organization through manychannels (Dlugacz, Restifo &

Greenwood, 2004). The Mayo Clinicteam used several vehicles to informstaff on the progress in fall preventionincluding staff and managementmeetings, newsletters and other pub-lications, patient safety meetings,committee presentations, and qualityconferences. During this phase, theteam evaluated what was workingand what processes needed revisions.Remember that the PDCA cycle iscontinuous and overlapping, so at anypoint in the cycle, you may have to goback to the planning stage if an inter-vention is not producing the resultsyou expected. This occurred when theteam found it was not getting enoughinformation on falls, which led to thedevelopment of the Ambulatory FallReport form.

Future DirectionsThe team is currently looking to

the future to determine what trendsexist in patient falls, as well as workingwith the information technologydepartment to develop a fall riskassessment tool in the latest version ofthe electronic medical record (EMR).In addition, to support communica-tion across all sites, including ambula-tory and inpatient settings, a falls alertscreen has been built into the EMRwhich will be readily accessed by anyhealth care provider in the system.The quality management nurse is

planning to use an improved databaseto input and retrieve data on falls.Finally, the team is exploring ways inwhich the risk assessment tool couldbe implemented in more areas of theambulatory clinic.

To ensure a safe environment forpatients, an ambulatory falls risk envi-ronmental tool has also been devel-oped. The team will continue tomonitor falls to answer those all-encompassing questions to decreasefurther incidence of falls: Who isfalling? Why are they falling? Whenare they falling? Where are theyfalling? Perhaps the ultimate ques-tion to ask is: You mean NO ONE hasfallen this month?

ConclusionPrevention of falls is complex and

requires a multi-interventionalapproach. The Ambulatory FallsPrevention Process ImprovementTeam at Mayo Clinic set out on a jour-ney to explore the incidence of fallsand reduce falls in the ambulatory set-ting. By evaluating our processes, poli-cies, and practices, and implementingnecessary changes, we were able toachieve our goal of reducing the inci-dence of falls. We feel confident thatthrough education and communica-tion, we will continue to see a down-ward trend in ambulatory falls.

Karen Seifert, MSN, RN, CDE, is aNursing Education Specialist, Mayo Clinic,Scottsdale, AZ. She can be contacted [email protected]

Acknowledgment: The authorwould like to acknowledge NancySpahr, MSN, CNS, RN, MBA, andStephanie Littman, RN, for their sup-port and efforts with this article.

ReferencesCenters for Disease Control and Prevention

(CDC). (2008). Falls among older adults:An overview. Retrieved from http://www.cdc.gov/HomeandRecreationalSafety/falls/adultfalls.html

Dlugacz, Y., Restifo, A., & Greenwood, A.(2004). The quality handbook for healthcare organizations. Hoboken, NJ:Jossey-Bass.

Joint Commission. (2009). National patientsafety goals. Retrieved from http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals

0

2

4

6

8

10

12

14

16

18

20

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Num

ber

of F

alls

Total ambulatoryfalls: All sites

Figure 2.2009 Fall Data: Total Falls


WWW.AAACN.ORG 11

Instructions for Continuing NursingEducation Contact Hours

We’re Not Falling for That:Preventing Falls in the Ambulatory Setting

To Obtain CNE Contact Hours1. For those wishing to obtain CNE contact hours, you must read the arti-

cle and complete the evaluation online through AAACN's OnlineLibrary. ViewPoint contact hours are free to AAACN members.

• Visit www.prolibraries.com/aaacn.• Click the "Verify Your Membership" button.• Fill in the appropriate information.• Log in with your existing Prolibraries account or create a new one.• Click on ViewPoint under "Publications" on the left hand side of the screen.• Read the ViewPoint article of your choosing, complete the online eval-

uation for that article, and print your CNE certificate immediately. 2. Evaluations must be completed online by April 30, 2011. Upon com-

pletion of the evaluation, a certificate for 1.1 contact hours may beprinted.

FeesAAACN members: FREE Regular price: $20

ObjectivesThe purpose of this CNE article is to describe how the PDCA (Plan-Do-Check-Act) cycle was used as a process improvement plan to examine thesafety issue of falls and implement an effective falls prevention program inan ambulatory setting. After studying the information presented in this arti-cle, you will be able to:1. Describe at least three intrinsic and three extrinsic risk factors for falls.2. Describe the key components of a fall risk assessment tool for an ambu-

latory setting.3. Identify effective interventions for the prevention of falls.

The author has not disclosed any affiliation or financial interest in relation to this educa-tional activity.

This educational activity has been co-provided by AAACN and Anthony J. Jannetti, Inc.

Anthony J. Jannetti, Inc. is accredited as a provider of continuing nursing education bythe American Nurses' Credentialing Center's Commission on Accreditation (ANCC-COA).

AAACN is a provider approved by the California Board of Registered Nurses, providernumber CEP 5336. Licenses in the state of CA must retain this certificate for four years afterthe CNE activity is completed.

These articles were reviewed and formatted for contact hour credit by RosemarieMarmion, MSN, RN, BC, CNA, BC, Education Director.

Lyons, S. (2005). Evidence-based protocol: Fall prevention for older adults.Journal of Gerontological Nursing, 31(11), 9-14.

McCarter-Bayer, A., Bayer, F., & Hall, K. (2005). Preventing falls in acute care: Aninnovative approach. Journal of Gerontological Nursing, 31(3), 25-33.

Murphy, T., Labonte, P., Klock, M., & Houser, L. (2008). Falls prevention for eld-ers in acute care: An evidence-based nursing practice initiative. Critical CareNurse Quarterly, 31(1), 33-39.

National Database of Nursing Quality Indicators (NDNQI). (July, 2009).Guidelines for data collection and submission on quarterly indicators.Retrieved from https://www.nursingquality.org

Peterson, R. & Berns, S. (2006). Prevention and education to decrease patientfalls due to syncope. Journal of Nursing Care Quality, 21(4), 331-334.

Sandras, W.A. (1995). Total quality control and the problem solving storyboard.Colorado Springs, CO: Productivity Centers International.

Wright, S., Goldman, B., & Beresin, N. (2007). Three essentials for successful fallmanagement: Communication, policies and procedures, and teamwork.Journal of Gerontological Nursing, 33(8), 42-48.

our Ambulatory Care Nursing Orientation andCompetency Assessment Guide. (Learn moreabout these new editions on page 7.)

As your president, I have been blessed towork with a very strong board and our manage-ment staff at A.J. Jannetti, Inc. I thank you forthis opportunity and look forward to continu-ing on the board as immediate past president,helping guide the work of this wonderfulorganization for one more year. I hope to seemany of you at the Las Vegas conference.

Kitty Shulman, MSN, RN,C, is Director, Children’sSpecialty Center, St. Luke’s Regional Medical Center,Boise, ID. She can be reached at [email protected]

Practice Resource Kit’ which can be found online(http://www.ons.org/ClinicalResources).

We asked ONS to provide some ‘QuickTips’ and journal articles that can be sharedamong the represented organizations on suchtopics as:

• What are the ‘red flags’ nurses need towatch for?

• Reports on research outcomes• Cancer care drug information summaries

for the non-cancer specialist nurse• Nursing implications in cancer care

It was suggested that more cancer careeducation be added into basic nursing pro-grams and that ONS provide more post-gradu-ate programming, demonstrating a commit-ment to continuous professional developmentwith online programs and a Speaker’s Bureau.As these initiatives take shape and educationbecomes available for AAACN members, theinformation will be shared in a future issue ofViewPoint.

Linda Brixey, RN, is Program Manager: ClinicalEducation, Immunizations, and Travel Medicine,Kelsey Seybold Clinic, Houston, TX, andDirector/Treasurer for AAACN. She can be reached [email protected]

Collaborating with NursingOrganizationscontinued from page 3

President’s Messagecontinued from page 2


Your idea l ca ree r de s t ina t ion.Explore your options at www.LeadingTheQuest.comCedars-Sinai welcomes and encourages diversity and is committed tomaintaining a drug- and alcohol-free workplace. EOE.

In the 2009 U.S. News & World Report rankings of America’s Best Hospitals, Cedars-Sinai MedicalCenter ranked among the top 50 hospitals in America in 11 specialty areas. If you consider yourselfamong the leaders in your field, we invite you to contribute to a healthcare provider who shares yourpassion for quality and excellence.

Nursing Education Program CoordinatorOur Ambulatory Care Administration has an immediate opening for a Nursing Education ProgramCoordinator to lead the development, coordination, implementation and evaluation of ambulatory careeducation programs for nursing personnel.

To qualify, you must have a BSN and Master’s degree, current California RN license and BLS. Ideally,you will possess relevant experience and certification in an ambulatory care nursing. Prior teachingexperience is required.

Please apply at https://www.cedars-sinaimedicalcenter.apply2jobs.com and apply to Requisition#352. For more information, email [email protected] or call (310) 423-5455.

Come hereto share knowledge.


WWW.AAACN.ORG 13

Return this form and Dermatology Nursing ®

will send you an invoice.OR

Subscribe online at www.dermatologynursing.net/offer

Take advantage of this special offer to subscribe toDermatology Nursing® the electronic journal forskin care professionals, and automatically receive new bonusbenefits from the DermatologyNursing Institute, LLC.**Not affiliated with the Dermatology Nurses’ Association

Subscription to Dermatology Nursing ® ($45 value per year)Free copy of new book What’s Your Assessment?(with 2-year subscription, $49 value)Free continuing nursing education credits through the journal($60 value per year)Printed clinical year-in-review issue each fallOnline discussion forumsDiscounted registration to the Dermatology NursingInstitute Congress (October 6-8, 2010, Las Vegas, NV)E-newsletterArticle archiveOnline education: Webcasts, articles, forums, and morePatient education fact sheets and many more exceptionaleducational materials and innovations

Subscriber Benefits $25 per year

With this special offer, you get all these benefits for LESS than a membership to most nursing associations!

1 Year – $25 (your first issue is free)2 Years – $50 (includes 2 free issues plus the new book –

What’s Your Assessment?)

Please start my online subscription to Dermatology Nursing®

Name: ________________________________ Title:________________

Address: __________________________________________________

City:______________________________ State:______ Zip: _________

Please Business address check (Business name __________________________________)one Home addressE-mail*: ___________________________________________________

* You will receive free E-news, practice updates, online content, free offers, and educational offerings as part of your subscription.

Professional status: RN NP LP/VN Medical Assistant Other:___________

Practice setting:Office Outpatient Inpatient Other: ____________________Send me more information about the Dermatology Nursing Institute.

All subscriptions come witha money-back guarantee.

For addresses outside of the United States,please add $10 for additional

postage per year.Dermatology Nursing®

East Holy Avenue, Box 56 Pitman, NJ 08071

856-256-2363 • [email protected]

Carol Ann Attwood isViewPoint Issue Editor

The ViewPoint Editorial Boardmembers continue to graciously taketurns serving as Issue Editors of thenewsletter. Carol Ann Attwood, MLS,AHIP, MPH, RN,C, is serving as IssueEditor for the second time with thisissue. Carol Ann has been a memberof the ViewPoint Editorial Board sinceApril 2009.

Carol Ann is a MedicalLibrarian/Registered Nurse, Patient and Health EducationLibrary, at Mayo Clinic in Arizona. Carol Ann manages thelibrary collection and her responsibilities include acquiringlibrary materials, coordinating library resources, and assistingconsumers in accessing reliable health care information. Priorto becoming a medical librarian, Carol Ann worked at MayoClinic in Arizona as a Registered Nurse in occupational andpreventive health medicine, quality management, clinicaland patient education, and telephone triage. Carol Ann hasbeen a member of AAACN since 2001. She was chair of thePatient Education Special Interest Group from 2004-2007, aswell as a member of the Conference Planning Committee in2008-2010. Additionally, she assisted with content for ambu-latory staff educator professional development.

Thank you, Carol Ann, for all you do for ViewPoint andAAACN!

Carol Ann Attwood


AAACN’s ManagementCompany Receives Top

Accreditation

Anthony J. Jannetti, Inc. (AJJ; www.ajj.com), AAACN’smanagement company, has been accredited by theAssociation Management Company (AMC) Institute. This isthe highest recognition an AMC can receive.

The accreditation process offered by the AMC Institute isthe most demanding and comprehensive in the industry.There are over 500 association management companiesworldwide and only 50 have earned this designation.

To earn the accreditation, AJJ demonstrated that it meetsthe highest industry standards for such business practices ascontracts and service delivery; employee recruitment, trainingand professional development; and financial management andinternal controls.

“I am so proud of our staff for their hard work and dedica-tion,” said Anthony Jannetti, AJJ president. “Not only are theyexperts at what they do, but they put their hearts into provid-ing innovative services for AAACN and other clients every day.”

AJJ has managed AAACN for more than 30 years, provid-ing full-service association management, public relations andmarketing, creative design and publishing, corporate sales,professional education, Web site and Internet, membershipand database management, and conference managementservices. AJJ publishes AAACN’s official newsletter, ViewPoint.

Administered by the AMC Institute (www.amcinstitute.org), AMC Institute Accreditation is recognized andsupported by the American Society of Association Executives(ASAE) & The Center for Association Leadership and is basedon the American National Standards Institute (ANSI) Standardof Good Practices for the AMC Industry.

Under the program, AJJ must earn re-accreditation everyfour years, demonstrating to an independent outside auditorthat the company continues to meet all standards.


LVM Systems, Inc.4262 E. Florian Avenue

Mesa, AZ 85206www.lvmsystems.com

CorporateMembers

Corporate members receive a variety of benefits, including recognition in ViewPoint,on AAACN's Web site, and in various conference-related publications, as well as pri-ority booth placement at AAACN's Annual Conference. For more information aboutCorporate Member benefits and fees, please contact Marketing Director TomGreene at [email protected] or 856-256-2367.

Call for Abstracts For 2011 Conference We are now accepting oral and poster abstracts for

next year’s conference in San Antonio, April 6-9, 2011.Oral presenters receive an honorarium. Both oral andposter presenters receive $100 off their registration fee.Download the criteria and application at www.aaacn.org(Events). The deadline for oral presentations is May 27,2010, and the poster deadline is January 3, 2011.

Welcome to AAACN’s New Education Director

Rosemarie Marmion, MSN, RN, BC,CNA, BC, has joined AAACN as EducationDirector. In her new role, Rosemarie helpsdevelop member education programs,implements nursing education activities,assures CNE activities provide contacthours that meet ANCC criteria, and workswith the editorial department on nursingjournals, newsletters, and electronicnewsletters.

Rosemarie has over 30 years experience in professionaldevelopment and nursing administration and has worked incommunity hospitals, health systems, and academic medicalsystems. Rosemarie worked previously as a Clinical NurseSpecialist, Continuing Education at Thomas JeffersonUniversity Hospital. Her nursing specialty is medical-surgicalnursing and she is certified in Professional Development andNursing Administration with ANCC. She lives in Deptford, NJ,with her husband, Bob, and has two children who are bothcurrently attending Rutgers University. Welcome, Rosemarie!

Rosemarie Marmion


WWW.AAACN.ORG 15

The Power of Words Communication is the transfer of information from one

entity to another. According to Albert Mehrabian (1981),an expert on verbal and nonverbal communication, only7% of face-to-face communication is the actual words thatare spoken. The rest is how the words are spoken, facialexpression, or nonverbal communication. In telehealthencounters, we must overcome the unseen face and stillconvey genuine concern and professionalism with ourwords. Each word carries a lot of meaning and influence.

Telephone encounters are a large part of care deliveryin ambulatory care. Patients depend on support and advicevia the phone, and the dialogue between the patient andcare provider is multi-faceted. This article will focus on thepower of the words spoken by the nurse caring for patientsby phone. The following actual patient situation illustratesthe power of words.

A Mother’s StoryA teenager had experienced a closed head injury.

Initially, he had been in critical care, then progressed to amedical unit and rehabilitation. During this journey, hismother was at his side. She assisted in his care and was filledwith hope. She realized his progress was slow and askednurses many questions. She received many answers thathad been supportive, empathetic, and informative. Thenone day, six words shattered all hope.

After the young man's discharge, the mother called thephysician's office to obtain some information. During herconversation with one of the nurses, she shared concernsabout her son's slow progress. The nurse curtly responded,"This may be all you get." The mother was stunned. If thatnurse had struck her face, it would not have been as painful.The mother was silent. She did not ask any further questions.

Immediately after hanging up with the nurse, the moth-er called a friend. The friend could not understand a wordbetween the sobs. Six words had changed everything.

The Nurse’s Story The nurse who had taken the call was knowledgeable

about the care of patients with neurological deficits. Whenshe received the call about this young man’s progress, shefelt she responded directly and realistically. She did notwant to offer false reassurances.

These two stories were never reconciled. The nurse doesnot know that her response created a sense of despair andhopelessness. The mother never informed the nurse thatthose six spoken words broke down the strength she hadbuilt up to care for her son who had so many complicatedneeds. This response caused devastating destabilization.

The Rest of the StoryFast forward several months…the teenage son contin-

ues to rehabilitate at home. He walks now with assistive

devices and communicates with a slurred but comprehensi-ble speech. He smiles again and is able to hug his mother.Progress has been slow, but steady. His mother has quit herjob and is caring for him full-time. She has learned manynew skills to take care of her son. She calls the physician’soffice frequently for guidance but always avoids “that onenurse.” Sadly, she states that she will never forget the wordsthat caused her so much pain. She remains tearful when sherecalls the brief interaction that occurred many months ago.

Practice PointsWhen interacting with a patient or a family member

over the phone, they will listen intently to your advice,information, and comments. Selecting the best words whileyou are managing multiple calls can seem daunting.However, if you adopt “good habits” with your word selec-tion, it will become more natural and less complicated. Hereare some hints to make the most of your words: 1. Remind yourself frequently how closely callers listen to

every word you speak.2. Select words carefully in each patient/family interac-

tion.3. Keep words objective. Avoid personal opinion.4. Choose phrases that are effective and well-received. 5. Listen to the caller’s selection of words and choose

words that will align.6. Remember that less can be more.7. And, remember that, sometimes, more is necessary.

Provision of care through the telephone is not ideal, butit is reality. Physician offices, call centers, and hospitalsreceive hundreds of calls per day with requests for advice,information, and education. Our words are extremely pow-erful, especially in the absence of our physical presence.Patients and families perceive us as experts; they hear ourevery word. Our words are the tools that can encourage,influence, and inspire.

Kathy Koehne, RNC, is a Nursing Systems Specialist, Departmentof Nursing, Gundersen Lutheran Health Systems. She may be con-tacted at [email protected]

ReferenceMehrabian, A. (1981). Silent messages: Implicit communication of

emotions and attitudes. Belmont, CA: Wadsworth.

What Our Members Are Saying

“Thank you for the free CNEs in ViewPoint!What a wonderful value for my membership.

It pays for itself!”

Lynette Fulton, RN-BCTeam Leader/Staff Nurse

Urgent Care Clinic, Kaiser PermanenteFontana, CA


Presorted StandardU.S. Postage

PAIDDeptford, NJPermit #142

Volume 32 Number 2

AAACN is the association of professional nurses and associates who identify ambulatory care practice asessential to the continuum of accessible, high quality, and cost-effective health care. Its mission is to advancethe art and science of ambulatory care nursing.

ViewPoint is published by theAmerican Academy of Ambulatory

Care Nursing (AAACN)

AAACN Board of DirectorsPresidentKitty Shulman, MSN, RN, CDirector, Children’s Specialty CenterSt. Luke’s Regional Medical Center

President-ElectTraci Haynes, MSN, RN, CENRegional Director of Clinical ServicesNational Healing Corporation

Immediate Past PresidentKaren Griffin, MSN, RN, CNAADeputy Associate Director for Patient CareServices/Nurse ExecutiveSouth Texas Veterans Healthcare System

Director/SecretaryLt. Col. Carol Andrews, USAF, NC, MS, RN-C,BC, CNASenior Program Manager, Care CoordinationAir Force Medical Operations Agency

Director/TreasurerLinda Brixey, RNProgram Manager, Clinical EducationKelsey Seybold Clinic

Directors

Judy Dawson-Jones, RN, MPHDirector of Ambulatory Care NursingThe Children’s Hospital of Philadelphia

Marianne Sherman, RN, C, MSEpic Nurse Champion - AmbulatoryUniversity of Colorado Hospital

Suzanne (Suzi) N. Wells, BSN, RNManager, St. Louis Children's Hospital

Executive DirectorCynthia Nowicki Hnatiuk, EdD, RN, CAE

Director, Association ServicesPatricia Reichart

AAACN ViewPointEast Holly Avenue, Box 56Pitman, NJ 08071-0056Phone: (800) AMB-NURSFax: (856) 589-7463 E-mail: [email protected] www.aaacn.org

Issue EditorCarol Ann Attwood, MLS, AHIP, MPH, RN,C

Editorial BoardPatricia (Tricia) Chambers, BHScN, DC, RNVirginia Forbes, MSN, RN, NE-C, BCLiz Greenberg, PhD, RNCLaura Morano, RN, CPN, MASusan Paschke, MSN, RN, BC, NEA-BCGinger H. Whitlock, RN, MSN, CNA

Managing EditorLinda Alexander

Editorial CoordinatorJoe Tonzelli

Layout DesignerBob Taylor

Education DirectorRosemarie Marmion, MSN, RN, BC, CNA, BC

Marketing DirectorTom Greene

© Copyright 2010 by AAACNAJJ-0310-V-2M

CHANGE SERVICE REQUESTED

New AAACN Board & Nominating CommitteeMembers Elected

The 2010 National Office Ballot was conducted electronically again this year. Memberswho commented on the process said casting their vote online was “easy and simple,” and“hassle-free, a few clicks and you are done!” In addition to electing new officers, membersalso approved amendments to the Bylaws.

The following members were elected and will take office at the close of the Las VegasConference:

President: Linda Brixey, RNDirector: Susan M. Paschke, MSN, RN-BC, NEA-BCDirector: Mary Vinson, MS, RN-BC, CMPEDirector: Suzanne Wells, BSN, RNNominating Committee: Debra L. Cox, MS, RN

Members interested in running for a national office are asked to contact a member ofthe Nominating Committee via the AAACN National Office at 800-262-6877 [email protected].

Linda Brixey Susan Paschke Suzanne WellsMary Vinson Debra Cox


€¦ · (met) nurse, several staff nurses and nurse managers, and a representative from the risk...

Documents